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The human body makes connections, and sometimes conditions can increase the likelihood of experiencing other conditions or health problems. Is there a connection between PCOS and diabetes?
September is PCOS Awareness Month. We’re doing our part to help spread the word by starting the conversation about the connection between PCOS and diabetes. You might be surprised by some of the information you read here – but it’s all based on fact and science. We hope you’ll pass this along to others who may be affected.
What is PCOS?
Polycystic Ovarian Syndrome (PCOS) is a hormone-driven condition that affects the ovaries and reproductive system. The most defining symptom is the development of multiple small, medium, or large fluid-filled follicles (often referred to as cysts) on one or both of the ovaries. However, simply having cysts on your ovaries isn’t enough.
Simply having cysts on your ovaries does not necessarily mean you have PCOS; cysts can be normal when they don’t cause any symptoms. For a diagnosis, you also need to struggle with other associated and systemic symptoms:
- Excessive production of androgens (male hormones)
- Heavy menstrual bleeding
- Irregular periods and/or spotting
- Excess hair growth (e.g., hair growth on the face)
- Acne and/or other skin struggles
Severe PCOS can also interfere with endocrine and metabolic function, including the ability to control or manage blood sugar levels. In fact, many women who suffer from PCOS also go on to be diagnosed with type 2 diabetes mellitus.
Unfortunately, researchers don’t yet know exactly why this happens; research is ongoing. Stil, the correlation is clear: people who are diagnosed with PCOS may be at risk for diabetes, too.
The PCOS – Diabetes Connection
Here’s what science knows about PCOS and diabetes (so far).
In PCOS, ovarian cysts cause widespread disruption of the endocrine system (hormones and metabolic function). This occurs because the body begins to produce far too many male hormones. High levels of androgens cause insulin receptors in the body to become resistant to insulin generated by the pancreas.
The pancreas, for its part, detects that resistance and kicks the body into overdrive, producing even more insulin to try and “catch up.” This results in hypoglycemia, or low blood sugar, which manifests as shakiness, dizziness, weakness, and often, extreme fatigue.
But how is it that low blood sugar leads to the high sugar levels associated with Type 2 diabetes? Essentially, pancreatic insulin-producing cells become exhausted over time. This results in a low output of insulin, which causes blood sugar levels to rebound and become too high. The patient is eventually diagnosed with diabetes.
Does Everyone With PCOS Develop Insulin Resistance or Diabetes?
No. However, the CDC reports that over half of all women diagnosed with the syndrome will go on to be diagnosed with diabetes before the age of 40. This effectively means your risk sits at about 50 percent after initial diagnosis. Being excessively overweight, having a family tie to diabetes, and not getting enough exercise or sleep may increase this risk even further.
What Causes PCOS?
An exact cause for this syndrome has yet to be identified. However, most studies do show evidence of a genetic link. If someone else in your immediate family is diagnosed with PCOS (particularly your parents or grandparents, you are more likely to be diagnosed with it, too. This is also the case for Type I and Type II diabetes, which makes the likelihood of a genetic influence extremely high.
Still, simply being related to someone with PCOS, PCOS-connected Type II diabetes, or Type I diabetes isn’t a guarantee you’ll suffer from it, too. Environmental influences, such as healthy diet, exercise, and early intervention, can make a big difference in diagnosis rates and, should you be diagnosed, prognosis.
How is PCOS Diagnosed?
The standard procedure for diagnosing PCOS is for the patient to have a thorough examination, including a PAP test. If you have cysts on your ovaries, your doctor may be able to detect them by palpitating your abdomen – this is often the first indication of a problem. However, failing to detect any masses is not sufficient to rule it out.
To confirm or rule out PCOS where the syndrome is suspected, doctors will often use a combination of bloodwork (to detect hormone problems) and ultrasound (to identify whether 12 or more cysts exist on the ovaries). Your doctor will also likely take the opportunity to measure your blood sugar and AIC levels to rule out either type of diabetes, since a dual diagnosis is so common.
The good news is that if you are diagnosed with PCOS, treatment options are available.
Treating PCOS and PCOS-Related Diabetes
While a considerable amount of trial and error is needed to find the right fix for the individual patient, some people see a complete reversal of symptoms just by taking birth control or anti-androgens. Lifestyle changes (e.g., losing weight and cutting back on excess sugar) can also help you feel better and regain control.
In moderate to severe PCOS where cysts become excessively large, surgery may be recommended to remove them – especially if they cause problems. However, this is generally reserved for situations where cysts cause extreme pain or where there is a risk for more serious complications, such as endometrial cancer.
Other drugs, including Clomiphene (Clomid) (an anti-estrogen), Letrozole (Femara) (an anti-cancer drug), and Gonadotropins (antiandrogens) may help alleviate fertility issues. However, they should only be used if you are monitored by a physician.
Medication can also help you gain control over PCOS-related diabetes, especially if you struggle with insulin resistance or high blood sugar levels. Injectable insulin is an option, but is rarely needed; instead, oral pills, such as Metformin, are preferred (and often better tolerated, too). The goal is to restore normal function and prevent both hypoglycemia and hyperglycemia at the same time.
Hope for Patients With PCOS
If you are diagnosed with PCOS with or without diabetes, take heart. While this can be a troublesome condition with difficult symptoms, new treatment options also give you a better chance at living a comfortable, healthy life than ever before. If you have questions about this or any other reproductive health concern, ask your pharmacist.